Blood vessel sensing catheter having working lumen for medical appliances

ABSTRACT

Devices and methods are disclosed for providing a sensing element to scan tissue and detect the presence of structures within the tissue to avoid the structures when performing a procedure on the tissue. A catheter includes a blood vessel sensing assembly and a working lumen adapted to receive a medical appliance or instrument for performing various medical procedures.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional of U.S. application Ser. No.12/406,018, filed on Mar. 17, 2009, which is a continuation ofInternational Application No. PCT/US2008/056069, filed Mar. 6, 2008,which claims priority to U.S. Provisional Application No. 60/893,174,filed Mar. 6, 2007, the contents of which are incorporated herein byreference in its entirety.

FIELD OF THE INVENTION

The invention is directed to devices for sensing movement within tissueat a target site to scan for the presence or absence of structures suchas blood vessels so that a procedure may be performed at the target sitein a safe manner.

BACKGROUND OF THE INVENTION

When performing procedures through an endoscope, bronchoscope, or othersuch device there is a risk that the procedure might disrupt structuresbeneath a tissue surface (such as blood vessels), where the disruptionthen causes significant complications.

One such area is within the airways of the lungs where puncturing of ablood vessel beneath the airway surface can result in significantbleeding. In cases where a scope type device is used, the bleedingobstructs the ability of the medical practitioner to visualize thedamaged area resulting in an escalation of complications. In some cases,a patient's chest must be opened to stem the bleeding.

Such risks occur in many types of scope-based procedures, including butnot limited to lung based approaches. For example, creation ofcollateral channels in COPD patients poses such risks. For example seeU.S. Pat. No. 6,692,494; U.S. patent application Ser. Nos. 09/947,144,09/946,706, and 09/947,126 all filed on Sep. 4, 2001; U.S. patentapplication Ser. No. 10/235,240, filed on Sep. 4, 2002; U.S. patentapplication Ser. No. 11/335,263, filed on Jan. 18, 2006; and U.S. patentapplication Ser. No. 11/562,947, filed on Nov. 22, 2006; each of whichis incorporated by reference herein in its entirety. In addition, biopsyprocedures, transbronchial aspiration procedures, and/or the use ofcytology brushes are a few procedures that present the same risk ofpenetrating a blood vessel within the lungs.

The problem is further compounded when accounting for motion of thetissue. For example, because airway or other lung tissue moves due totidal motion of the lungs (as a result of the mechanics of breathing),it is difficult to visually identify an area that was previously scannedunless the scanning device remains relatively stationary against thetissue. Moreover, the difficulty increases when considering that theprocedure takes place through the camera of a bronchoscope or endoscope.

Aside from the risk to the patient, a medical practitioners that causespuncturing of a blood vessel is often understandably hesitant or riskadverse when performing future procedures. As a result, while thebenefit of these procedures is well known, the risks of complicationsmay reduce the overall success of the procedure.

In view of the above, a need remains to increase the safety whendisrupting tissue beneath a tissue surface where the disruption couldcause complications on structures hidden beneath the tissue surface Sucha need remains in procedures that create channels to vent trapped gasseswithin the lungs, transbronchial aspiration procedures, transesophagealprocedures, biopsy procedures, use of cytology brushes, etc.Furthermore, the need may arise in any lung based procedure or otherprocedures in other parts of the body.

SUMMARY OF THE INVENTION

The invention relates to devices and method for sensing structureswithin tissue (such as blood vessels or other organs) while performing aprocedure at the site.

The catheter member can be a tubular member as commonly used in medicaldevice applications. Accordingly, the catheter member can be a polymerictube or a reinforced polymeric tube. As described herein, it may haveone or more lumens to accommodate the variations of the devices withinthis disclosure.

The sensing assembly is used to scan the tissue to minimize causingundesirable injury to the patient. As discussed below, any number ofsensing modes may be incorporated into the device. However, it was foundthat Doppler ultrasound transducer assemblies perform acceptably whensensing for blood vessels within tissue. In certain variations, thesensing assembly may be configured to puncture the tissue and create theopening. However, in other variations, the sensing assembly will have ablunted tip to minimize undesirable tissue damage.

In variations of the device, the sensing assembly is offset from an axisof the catheter assembly. Doing so improves the ability of the sensingassembly to contact tissue surfaces when the device is advanced alongbody conduits. In addition, this offset feature improves the ability tosee the tip of the sensing assembly when the device is used with a scopetype device.

The invention further includes methods of treating tissue, where themethod includes selecting an area in the tissue for treatment, advancinga device into the lung to a tissue site, where the device includes asensing assembly affixed to a catheter to sense for the presence orabsence of blood vessels. The device may then allow for the use of amedical appliance such as an aspiration needle, a transbronchialaspiration needle, a forceps, a coring device, a cytology brush, etc, toperform a procedure at the site without removing the sensing assemblyfrom the tissue site.

As noted herein, one variation of the device permits scanning the tissuesite by placing the sensing assembly in contact with the tissue site.However, various sensing assemblies may permit non-contact scanningRegardless of whether the sensing tip contacts the tissue, creation ofthe opening may be performed without significant movement of thescanning assembly. Such a benefit is apparent as medical practitionersmay lose track of the scanned tissue if they are required to substituteor move the scanning assembly to create an opening.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A shows a variation of a system as described herein.

FIG. 1B shows a far end of a catheter according to the presentinvention.

FIGS. 2A-2F show variations of the ends of devices.

FIGS. 3A-3C show additional variations of the device.

FIG. 4A-4D illustrate various medical appliances for use with thesensing device.

FIGS. 5A-5B illustrate a non-exhaustive sample of variations oftransducer assemblies.

FIGS. 6A-6D, illustrate possible variations of optional sensing tips foruse with the transducer assembly.

FIG. 7 illustrates an example of using the device to scan a target siteprior to, during, and after performing a procedure at the target site.

DETAILED DESCRIPTION OF THE INVENTION

FIG. 1A illustrates a view of a variation of the inventive system 150.The system generally includes a device 200 having a sensing element 208located at a distal tip 203 of a catheter member 202. In the variationshown, the distal tip 203 protrudes from a distal portion of thecatheter member 202.

The catheter member 202 may be a single or multi-lumen tube. However, inmost variations, the catheter member 202 is sufficiently long andflexible so that the distal end of the device 200 can access remoteareas within tortuous anatomy (such as the lungs).

FIG. 1B illustrates a magnified view of the distal end of the device 200of FIG. 1A. As shown, a lumen 215 running through the catheter member202, exits the catheter at an opening that is spaced proximally from thedistal tip 203.

As shown in FIG. 1A, the device 200 also includes a handle portion 196.Typically, the handle portion 196 may be of any known handle typeconfiguration commonly used with medical devices. However, in somevariations of the device, the handle portion 196 allows manipulation ofthe device 200. When the device 200 is used with another medicalappliance (as noted below) then handle 200 can either engage theappliance (e.g., by coupling with the appliance) or provides a surfacefor manipulation of the appliance relative to the device 200. Typically,the handle includes a fitting, flange, threaded portion, female luer, orother connection 230 for coupling various medical appliances. Suchmedical appliances include aspiration needles, transbronchial aspirationneedles, biopsy devices, brushes, forceps, and other such devices thatcould be advanced through the lumen of the catheter 202 to the targetsite at the end of the device 200. In most variations, such medicalappliances are of a small diameter. The use of the connector 230provides a more convenient opening for insertion of a small device. Forinstance, attempting to insert an aspiration needle (e.g., 17-21 gauge)into a small diameter lumen will be a time consuming effort. Use of aconnector 230 permits the medical practitioner to rapidly insert such asmall sized appliance into the device 200.

The handle 196 may optionally include a sliding mechanism or actuator194 that can be coupled to the medical appliance that is advancedthrough the port or connection 230. This coupling permits the medicalpractitioner to advance or retract the medical appliance with a singlehand that is already manipulating the device 200.

In one variation, the device 200 may be coupled to a control system 190that is configured to assist the medical practitioner in detectingwhether blood vessels are at or near a particular target site. Thesensing assembly 206 and control system 190 may be any type of unit thatconfirms the presence or absence of blood vessels. As such, it may be athermal based system (incorporating a temperature detecting element,thermocouple, RTD, etc.), light based system (incorporating afiber-optic system to measure reflected light or energy), ultrasoundbased system, or Doppler based system. The sensing element may providean image or may simply provide sound or other data. The system 150 mayalso include various other components as required (e.g., fluid sources,medications, vacuum sources for aspiration, etc.)

For exemplary purposes, the control system 190 and sensing assembly 206are discussed herein as being a Doppler ultrasound system. As such, thesensing assembly 206 includes a sensing tip 208 that is coupled to thepower supply 190 as is known by those familiar with such systems. Forexample, the sensing assembly 206 may include any number of conductingmembers (e.g., wires) extending along the catheter member 202 (eitherinternally or externally to the catheter member 202). In any case, theseconducting members provide the energy and controls for the sensingassembly 206. In the case of Doppler ultrasound, the conducting memberscouple an ultrasound source 190 to the sensing tip 208 that comprises anultrasound transducer assembly or lens.

Moreover, variations of the inventive device include conducting membersthat comprise a series of wires, with one set of wires being coupled torespective poles of the transducer, and any number of additional sets ofwires extending through the device. In addition, the sensing assembly206 may have more than one sensing surface disposed along the portion ofthe sensing assembly 206 that extend from the device.

As discussed herein, any conventional sensing type probe may be used todetect the blood vessel. When using Doppler ultrasound to detect thepresence of blood vessels within tissue, the ultrasound can operate atany frequency in the ultrasound range but preferably between 2 Mhz-30Mhz. It is generally known that higher frequencies provide betterresolution while lower frequencies offer better penetration of tissue.In the present invention, because location of blood vessels does notrequire actual imaging, there may be a balance obtained between the needfor resolution and for penetration of tissue. Accordingly, anintermediate frequency may be used (e.g., around 8 Mhz). A variation ofthe invention may include inserting a fluid or gel into the airway toprovide a medium for the Doppler sensors to couple to the tissue todetect blood vessels. In those cases where fluid is not inserted, thedevice may use mucus found within the airway to directly couple thesensor to the wall of the airway.

As noted above, Doppler ultrasound was found to be an efficient way toidentify blood vessels. As such, the control system 190 can beconfigured to communicate with an analyzing device or control unitadapted to recognize the reflected signal or measure the Doppler shiftbetween the signals. The source signal may be reflected by changes indensity between tissues. In such a case, the reflected signal will havethe same frequency as the transmitted signal. When the source signal isreflected from blood moving within a vessel, the reflected signal has adifferent frequency than that of the source signal. This Doppler Effectpermits determination of the presence or absence of a blood vesselwithin tissue. The Doppler system described herein comprises a Dopplerultrasound mode of detection. However, additional variations includetransducer assemblies that allows for the observation of the DopplerEffect via light or sound as well.

Regardless of the mode incorporated by the sensing assembly, the system150 may include a user interface that allows the user to determine thepresence or absence of a blood vessel at the target site. Typically, theuser interface provides an audible confirmation signal. However, theconfirmation signal may be manifested in a variety of ways (e.g., light,graphically via a monitor/computer, etc.)

Although depicted as being external to the device, it is contemplatedthat the control system 190 may alternatively be incorporated into thedevice 200. Moreover, the system 150 may incorporate any number ofconnectors or fitting that allow for either permanent or detachableconnections of the fluid source, control system and/or any otherauxiliary systems used with the system 150.

FIGS. 2A to 2B illustrate various configurations of the far end of thecatheter member 202 to illustrate variations of sensing assembly 206configurations relative to the opening of the lumen 215. As noted, thedevice may include any number of lumens.

FIG. 2A shows a variation of a sensing element 208 having a segment 211that extends from the tip of the catheter 202 and where the opening ofthe lumen 215 is tapered. As discussed herein, in most variations, thesensing tip 208 is fixed and extends a distance beyond the catheter 202so that the tip 208 may be pressed against tissue to scan for bloodvessels or other structures. Once the practitioner locates an acceptablesite, the practitioner advances the medical appliance to perform aprocedure at the site.

FIGS. 2B-2F illustrate variations of sensing assemblies 206 in which thesegments 211 are offset from a central axis of the catheter member 202.Offsetting the sensing element 208 from the opening of the lumen 215decreases the chance that the sensing tip 208 will be obscured by thecatheter member 202 when viewed by the end of the bronchoscope orendoscope.

FIG. 2B illustrates another variation of a sensing element 208 extendingfrom the far end of a catheter member 202. In this variation, thesensing element 208 is located on an extension segment 211 that isaffixed to the catheter member 202. FIG. 2B also shows a device orappliance 300 extending within the lumen 215. The segment 211 may extendthrough the length of the catheter member 202 or may be terminated nearthe far end of the catheter member 202 with the conductive elements(e.g., wires) extending to the control system (not shown). In somevariations, the segment 211 extends through the device but the portionextending from the far end of the catheter is stiff/has a sufficientcolumn strength to probe tissue while a remainder of the segment has alower stiffness/column strength to accommodate flexibility of thedevice. In any such constructions, the conductive element (or segmentportion that extends in the device) does not significantly reduce theability to navigate the device through tortuous anatomy.

FIG. 2C illustrates another variation of a in which the sensing tip 208is angled away from a central axis of the catheter member 202. Such afeature is useful when trying to sense along a wall of a body passagebecause less articulation of the catheter 202 is required to cause thesensing tip 208 to contact the tissue.

FIG. 2D shows another variation of an offset sensing assembly 206. Inthis variation, the segment 211 may comprise a tube or similar memberthat extends along and externally to the length of the catheter member202.

FIG. 2E illustrates yet another variation, similar to that of FIG. 2Aabove, where the opening of the lumen 215 is not tapered. In thisvariation, the catheter 202 includes a second lumen 222 through which asensing assembly (not shown) may be secured.

FIG. 2F shows another variation in which a segment 211 of a sensingassembly is inserted into the far end of the catheter member. Thesegment 211 may have connections for coupling to a control system asdescribed above. In such a variation, the catheter member 202 may be amulti-lumen tube with one or more lumens reserved for the sensingassembly. In addition, the location of the segment 211 may be offset asdescribed above. Alternatively, the segment 211 may be placed in thecenter of the catheter member 202. Given this configuration, the lumenfor a dilation member such as a dilator or an expandable balloon (notshown) is offset.

The degree to which the segment 211 and sensing tip 208 extend from thecatheter member 202 may vary depending on the particular application.For example, in certain variations, the sensing tip may be immediatelydistal to the end of the catheter member. In alternate variations, thesensing tip may extend as shown in the drawings. Such a construction isuseful when the practitioner desires to insert the sensing tip 208 intoan opening within the tissue to perform additional scanning

FIG. 3A illustrates another variation of a device 200. In thisvariation, the device 200 includes a “partial-handle” 196 typeconfiguration. The handle 196 includes a coupling element 198 forengaging a medical appliance 300 (in this case a trans-bronchialaspiration needle). The coupling element 198 can be manipulated by theactuator 194 on the handle 196. Optionally, the appliance 300 mayinclude a fitting 302 such as a luer lock or hub that engages the handle196 so that the appliance 300 may be coupled to the catheter device 200.As shown, the appliance 300 may be coupled to an auxiliary unit 192(such as a vacuum source).

FIGS. 3B-3C illustrate another variation of a device in which theconnector 230 is located to a side of the device 200 allowing forloading of the medical appliance 300 through a side of the device ratherthan through the proximal end. As shown, the handle 196 may also includean actuating member 194 for advancing and/or retracting the appliance300 once inserted through the device. In an application, medicalappliance 300 (e.g., a transbronchial aspiration needle) is insertedthrough connector 230 and advanced until hub 231 is secured to theconnector. The hub and connector may be a wide variety of structuresincluding, for example, a male and female luer connector.

Although not shown, the device lumen 215 can be configured to hold anynumber of medical appliances (including forceps, needles, brushes, etc.)where the appropriate device may be temporarily secured to the handleportion 196 or a coupler. Accordingly, such a variation permits thedevice to function as a housing for the various medical appliances.

FIGS. 4A-4D illustrate some possible variations of medical appliances300 for use in the device. As noted above, the appliance may be a simpleaspiration needle 304 or a trans-bronchial aspiration needle.Alternatively, the appliance may be a biopsy device (e.g., a coringdevice) or the forceps 306 as shown in FIG. 4B. Another variation of theappliance may include a brush (e.g., a cytology brush) that obtainstissue samples when moved against the tissue site. FIG. 4D illustratesanother variation of an appliance 300. In this variation, the appliance300 includes a removable working tip 310. The working tip 310 may beinterchangeable with other working tips to perform a number of functions(e.g., coring, aspiration, tissue sampling, etc.)

It was noted above that the sensing element 208 can include any numberof sensing modes as discussed above. One such possible mode includes atransducer assembly as shown in FIGS. 5A-5B

FIG. 5A illustrates a cross-sectional view of a basic variation of atransducer assembly 302. The transducer assembly 302 includes at leastone transducer 308 (e.g., a piezoelectric transducer.) In thisvariation, the front surface of the transducer 308 comprises a firstpole and the rear surface comprises a second pole.

The transducer or transducers may comprise a piezo-ceramic crystal(e.g., a Motorola PZT 3203 HD ceramic). In the current invention, asingle-crystal piezo (SCP) is preferred, but the invention does notexclude the use of other types of ferroelectric material such aspoly-crystalline ceramic piezos, polymer piezos, or polymer composites.The substrate, typically made from piezoelectric single crystals (SCP)or ceramics such as PZT, PLZT, PMN, PMN-PT; also, the crystal may be amulti layer composite of a ceramic piezoelectric material. Piezoelectricpolymers such as PVDF may also be used. Micromachined transducers, suchas those constructed on the surface of a silicon wafer are alsocontemplated (e.g., such as those provided by Sensant of San Leandro,Calif.) As described herein, the transducer or transducers used may beceramic pieces coated with a conductive coating, such as gold. Otherconductive coatings include sputtered metal, metals, or alloys, such asa member of the Platinum Group of the Periodic Table (Ru, Rh, Pd, Re,Os, Ir, and Pt) or gold. Titanium (Ti) is also especially suitable. Thetransducer may be further coated with a biocompatible layer such asParylene or Parylene C.

The covering 306 of the transducer assembly 302 may contain at least aportion of the transducer 308. In some variations of the invention, thecovering 306 may comprise a conductive material. In such cases thecovering 306 itself becomes part of the electrical path to the firstpole of the transducer 308. Use of a conductive covering 306 may requireinsulating material 313 between the sides of the transducer 308, therebypermitting a first conductive medium 314 to electrically couple only onepole of the transducer 308 to the covering 306.

At least a portion of the front surface of the transducer 308 will be incontact with the conductive medium 314. The conductive medium 314permits one of the poles of the transducer 308 to be placed incommunication with a conducting member that is ultimately coupled to apower supply. As shown in this example, the conductive medium 314 placesthe pole of the transducer 308 in electrical communication with thecovering 306. In some variations the conductive medium 314 may coat theentire transducer 308 and covering 306. Alternatively, the conductivemedium 314 may be placed over an area small enough to allow for anelectrical path between a conducting member and the respective pole ofthe transducer 308. The conductive medium 314 may be any conductivematerial (e.g., gold, silver, tantalum, copper, chrome, or anybio-compatible conductive material, etc. The material may be coated,deposited, plated, painted, wound, wrapped (e.g., a conductive foil),etc. onto the transducer assembly 302.

The transducer assembly 302 depicted in FIG. 5A also illustratesconducting members 320, 322 electrically coupled to respective poles ofthe transducer 308. Optionally, the conducting members 320, 322 may beencapsulated within an epoxy 311 located within the covering 306. Theepoxy 311 may extend to the transducer 308 thereby assisting inretaining both the conducting members 320, 322 and transducer 308 withinthe covering. It may also be desirable to maintain a gap 328 between thetransducer 308 and any other structure. It is believed that this gap 228improves the ability of the transducer assembly 302 to generate asignal.

FIG. 5B illustrates another variation of a transducer assembly 302. Inthis variation, the conductive medium 314 extends over the entiretransducer covering 306. Accordingly, the covering 306 may be made of anon-conducting material (e.g., a polyamide tube, polyetherimide,polycarbonate, etc.) The transducer assembly 302 may further comprise asecond tube 316 within the covering 306. This second tube 316 may be ahypo-tube and may optionally be used to electrically couple one of theconducting members to a pole of the transducer 308. As shown, thecovering 306 may contain a non-conductive epoxy 310 (e.g., Hysol2039/3561 with Scotchlite glass microspheres B23/500) which secures boththe conducting member and the second tube 316 within the covering 306.This construction may have the further effect of structurally securingthe transducer 308 within the assembly 302. Again, a gap 328 may or maynot be adjacent to the transducer to permit displacement of thetransducer 308.

FIG. 5B also illustrates the assembly 302 as having a conductive epoxy312 which encapsulates the alternate conducting member 320. An exampleof a conductive epoxy is Bisphenol epoxy resin with silver particulatesto enable conductivity. The particulates may be from 70-90% of the resincomposition. The resin may then be combined with a hardener (e.g., 100parts resin per 6 parts hardener.) The conductive epoxy 312 is inelectrical communication with the conductive medium 314 allowing for aconductive path from the conducting member 320 to the conductive medium314. Accordingly, use of the conductive epoxy 312 secures the conductingmember 320 to the assembly 302 while electrically coupling theconducting member 320 to the transducer via the conductive coating 314.

Although variations of the transducer assembly include a tip andhousing, the invention may omit the transducer covering and otherstructures not necessary to generate a source signal and receive areflected signal. Therefore, it is contemplated that the invention maysimply have a transducer that is coupled to a controller.

When used in the devices 200 described herein, the tip 208 of thesensing assembly may comprise the transducer 308 shown above, or thecoating 314. In alternative variations, the tip 208 of the sensingassembly may comprise a tip 304 that is affixed to the transducerassembly 302 and as shown in FIGS. 6A-6D.

FIGS. 6A-6D, illustrate possible variations of tips 304 for use with thetransducer assembly. It is noted that these variations are provided forillustrative purposes and are not meant to be exhaustive. The tips 304of the present invention may function simply as a blunting tip (butstill passes and receives ultrasound signals) or as a lens to disperseand/or direct the signal over a substantial portion of the outer surfaceof the tip 304. When configured to function as a lens, the tip 304 isadapted to disperse and/or direct (e.g., by diffraction) a reflectedsignal towards the transducer (not shown in FIGS. 6A-6D). Accordingly,given the above described configuration, the inventive device 300 willbe able to detect vessels with substantially most of the tip 304. Thetip may comprise a signal directing means.

When configured to function as a lens, the tip 304 is designed such thatit interferes and redirects the signals in a desired direction in amanner like a lens. It also may be desirable to place an epoxy betweenthe tip 304 and the transducer. Preferably, the epoxy is thin andapplied without air gaps, bubbles or pockets. Also, the density/hardnessof the epoxy should provide for transmission of the signal whileminimizing any effect or change to the source signal. The configurationof the transducer assembly 302 permits the lens tip 304 to disperse asignal over a substantial portion of its outer surface 244. The lens tip304 also is adapted to refract a reflected signal towards the transducer308. Accordingly, given the above described configuration, the inventivedevice will be able to detect vessels with any part or substantially theentire lens tip 304 that contacts tissue.

Although the tip of the present invention is able to transmit a sourcesignal and receive a reflected signal, the invention is not limited torequiring both functions. For example, the inventive device could beconfigured to generate a source signal and direct the source signal toan area of interest but a second device or transducer assembly could beused to receive the reflected signal. Accordingly, a separate devicecould be used to generate the source signal with the inventive devicebeing used to receive the reflected signal.

The tip 304 may be comprised of materials such as a dimethyl pentene, amethylpentene copolymer (plastic-TPX), aluminum, carbon aerogel,polycarbonate (e.g., Lexan), polystyrene, etc., or any other standardmaterial used for ultrasound applications.

As illustrated in FIG. 6A, although the front surface 344 of the tip 302is illustrated as being hemispherical, the tip 304 may have otherprofiles as well. For example, it is desirable that the tip 304 producea certain amount of divergence of the signal being passed therethrough.However, depending on a variety of factors (e.g., material, frequency ofthe signal, etc.) a tip 304 may encounter excessive divergence which isdestructive to the outgoing signal. Accordingly, it may be desirable toproduce a tip 304 as illustrated in FIG. 6B in which a front surface 344of the tip 304 is substantially flat. The degree of flatness of the tip304 will often depend upon experimentation to reduce the amount ofdestructive reflections, thus minimizing excessive divergence due todifferences in speed of sound in tip versus tissue. For example, whenusing a tip that is conducive to an ultrasound signal (e.g., TPX) arounded tip can be used since there is not excessive divergence of thesource signal. Use of a material that is not as conducive to ultrasoundrequires a flatter tip due to the resulting divergence of the sourcesignal. FIG. 6C illustrates another variation of a tip 304 having arounded front surface 344 but with no projections on the sides of thetip 304. FIG. 6D illustrates a tip 304 with a concave front surface 344.

In any case, the tip will be configured to avoid sharp edges that maycause any unintended damage to tissue while the device is being used todetermine the presence or absence of a blood vessel. In such a case, forexample, the tip may be designed such that it doesn't have sharp edges,or any sharp edges may be covered by other parts of the device (e.g.,the elongate member, an outer sheath, etc.)

Commonly assigned patent publication nos. U.S. 20020128647A1; U.S.20020138074A1; U.S. 20030130657A1, and U.S. 20050107783A1; discloseadditional variations of transducer assemblies and modes of securingsuch assemblies to the device. The entirety of each of which isincorporated by reference herein.

FIG. 7 illustrates an example of use of the devices described herein.Although the figures show a single variation, it is contemplated thatany variation of the device may be substituted. In the illustratedexample, the device creates an extra-anatomic passage in the airway walltissue within a lung. However, it is understood that the device may beused in any part of the body and for any application. For example,variations of the device may be used during a biopsy procedure to scanfor blood vessels, and remove a biopsy sample within the tissue piercingmember.

FIG. 7 shows an access device 120 advanced into the airways 100 of alung. The access device 120 may be a bronchoscope, endoscope,endotracheal tube with or without vision capability, or any type ofdelivery device. The access device 120 will have at least one lumen orworking channel 122. In the illustrated version, access device 120includes a light 124 and vision 126 capabilities. For example, locationof the site may be accomplished visually, or with additional equipmentsuch as a CT scan to locate areas for treatment. In cases where theaccess device 120 is a bronchoscope or similar device, the access device120 is equipped so that the surgeon may observe the intended target site114. In some cases it may be desirable for non-invasive imaging of theprocedure. In such cases, the access device 120 as well as the otherdevices discussed herein, may be configured for detection by theparticular non-invasive imaging technique such as fluoroscopy,“real-time” computed tomography scanning, or another technique beingused.

FIG. 7 also illustrates advancement of a variation of the inventivedevice 200 through the channel 122 of the access device 120 towards thetarget site 114. The medical practitioner then uses the sensing element208 to inspect the target site 114 to determine whether a blood vessel101 is adjacent to the site. If a blood vessel is detected at or nearthe site 114, then another target site may be selected.

Once the practitioner determines that the site is free of any bloodvessel 101, the practitioner may insert the medical appliance 300 (inthis case a transbronchial aspiration needle) into the target sitewithout removing the catheter 200 and sensing element 208 from thetissue. Accordingly, variations of the device require sufficientstiffness so that the tissue may be adequately probed without collapseof the sensing element 208 or the segment carrying the element. Asdescribed above, the system 150 provides the medical practitioner withaudio or visual signals so that the practitioner can determine whetherit is sufficiently safe to make an opening in the tissue.

A further variation of the invention may include configuring thetransducer assembly and/or controller to have different levels ofsensitivity. For example, a first level of sensitivity may be used toscan the surface of tissue. Then, after creation of the opening, thesecond level of sensitivity may be triggered. Such a featureacknowledges that scanning of tissue on, for example, the airway wallmay require a different sensitivity than when scanning tissue within theparenchyma of the lung.

It should be noted that the invention includes kits containing theinventive device with any one or more of the following components, aDoppler ultrasound controller, a conduit delivery catheter and aradially expandable conduit detachably connected to the distal end ofthe delivery catheter, as described in one or more of the applicationslisted above, and a bronchoscope/endoscope.

In the above explanation of Figures, similar numerals may representsimilar features for the different variations of the invention.

The invention herein is described by examples and a desired way ofpracticing the invention is described. However, the invention as claimedherein is not limited to that specific description in any manner.Equivalence to the description as hereinafter claimed is considered tobe within the scope of protection of this patent.

Additionally, the devices of the present invention may be configured tolocate a target site for creation of a collateral channel in the tissueand to create an opening in tissue. As discussed above, a benefit ofthis combination feature is that a single device is able to select atarget location and then create an opening without having been moved.Although the device is discussed as being primarily used in the lungs,the device is not limited as such and it is contemplated that theinvention has utility in other areas as well, specifically inapplications in which blood vessels or other structures must be avoidedwhile cutting or removing tissue (one such example is tumor removal).

The above illustrations are examples of the invention described herein.It is contemplated that combinations of aspects of specificembodiments/variations or combinations of the specificembodiments/variations themselves are within the scope of thisdisclosure.

1. A method for performing a surgical procedure on tissue in an organ,the method comprising: advancing a far end of a catheter into a bodypassageway and in the vicinity of the tissue where the catheter has aworking channel and a sensing element assembly that is affixed to thecatheter and is offset from an axis of the working channel; sensing forthe absence of blood vessels along the body passageway using the sensingelement assembly associated with the far end of the catheter; extendinga working tip of a medical appliance from the working channel at the farend of the catheter, through a wall of the body passageway, and into thetissue such that catheter does not obscure the sensing element assembly;and performing the surgical procedure with the appliance.
 2. The methodof claim 1, where the medical appliance is a biopsy coring device. 3.The method of claim 1, further comprising the step of advancing a scopeinto the body passageway, and advancing the catheter through a lumen inthe scope.
 4. The method of claim 1, where the far end of the cathetercomprises a distal opening for the working tip of the medical applianceto exit, and wherein the opening is beveled.
 5. The method of claim 1,wherein the sensing element assembly is positioned distal to the distalopening.
 6. The method of claim 1, where the medical appliance comprisesan aspiration needle, a transbronchial aspiration needle, a forceps, abrush, and a biopsy coring device.
 7. The method of claim 1, where thesensing element comprises an element selected from the group consistingof a Doppler Ultrasound transducer assembly, temperature detectingelement, and a light detecting element.
 8. The method of claim 1, wherethe far end of the catheter comprises a distal opening for said workingtip of said medical appliance to exit, and wherein said opening isbeveled.
 9. The method of claim 1, where the sensing element comprises astiff portion extending from the far end of the catheter, and wheresensing for the absence of blood vessels comprises probing tissue withthe stiff portion of the sensing element.
 10. The method of claim 1,where the near end of the catheter comprises a handle portion having anactuator, and moving the actuator to advance and retract the medicalappliance at the opening.